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Pediatric Respiratory Disorders PowerPoint PPT Presentation

Pediatric Respiratory Disorders. Revised Fall 2010 Susan Beggs, RN MSN CPN. Describing the differences between adult and pedi client. Differences between the very young child and the older child Resistance can depend on many factors

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Pediatric Respiratory Disorders

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Waiting up to 72 hrs for spontaneous resolution is now recommended in healthy infants

When abx warranted, oral amoxicillin in high dosage TOC

Nursing Care Management for OM

Nursing objectives:

Relieving pain

Facilitating drainage when possible

Preventing complications or recurrence

Educating the family in care of the child

Providing emotional support to the child and family

Preparing the child for surgery

A myringotomy or pin hole is made in the ear drum to allow fluid removal. Air can now enter the middle ear through the ear drum, by-passing the Eustachian tube. The myringotomy tube prevents the pin hole from closing over. With the tubes in place, hearing should be normal and ear infections should be greatly reduced.

Tonsillitis

Causative agents for tonsillitis

May be bacterial or viral

Most common bacterial agent: Group A beta-hemolytic strep

Throat cultures must be done to determine origin

Older child may develop peritonsillar abscess

Treatment for tonsillitis

Treatment is symptomatic

Antibiotics restricted to those with bacterial infection

Drug of choice: amoxicillin

Surgery (with recurrent infections)

Nurse Alert!

The nurse should remind the child with a positive throat culture for strep to discard their toothbrush and replace it with a new one after they have been taking antibiotics for 24 hours

Nursing Care for the Tonsillectomy and Adenoidectomy Patient

Why is collection of blood for assessment of bleeding and clotting times so important?

Nursing Care for the Tonsillectomy and Adenoidectomy Patient

Pre-operative preparation

Providing comfort and minimizing activities or interventions that precipitate bleeding

Place on abd until fully awake

Manage airway

Monitor bleeding, esp. new bleeding

Ice collar, pain meds

Avoiding po fluids until fully awake..then liquids, soft

Post-op hemorrhage can occur

Nurse Alert for Post-Op T/A surgery

Most obvious sign of early bleeding is the child’s continuous swallowing of trickling blood.

While the child is sleeping,

note the frequency of

swallowing and notify

the surgeon immediately

Discharge teaching

Monitor child at home for:

Excessive swallowing

Signs of fresh bleeding

Vomiting bright red blood

Restlessness not associated with pain

Keep child quiet for 1 wk after surgery

Avoid red liquids (might appear as blood)

Do not allow straws!

Discourage from coughing

Awareness of “scab” in 7-10 days

Apnea

Defined as delay of breathing over 20 seconds

Manifestations

Diagnostic tests

Therapeutic Interventions and Nursing Care

Categories of apnea

Prematurity: most common and may vary among neonates

Infant apnea: no known cause; r/o seizures, GERD, hypoglycemia

Apnea vs Periodic Breathing

Apnea:

Cessation > 20 seconds

S/S to assess:

Cyanosis

Marked pallor

Hypotonia

bradycardia

Periodic breathing

Normal breathing pattern of NB but never > 10-15 seconds

Even though normal, all parents are taught CPR for their NB

Diagnostics for apneic episodes

Pneumocardiography

CXR

Blood chemistry studies

ECG

EEG

Nursing responsibilities in caring for an infant with apnea

Nurse sets parameters for HR according to age

Gentle stimulation of infant

Maintaining a neutral environment

Instruct family with apnea monitors at home

Instructions to families with apnea monitors at home

Must know CPR!

24 hr coverage is available for emergencies

Parents should maintain a diary of episodes

Have them verbalize their fears associated with the apnea

SIDS

Defined: sudden death of an infant during sleep

Etiology

Assessment

Therapeutic Interventions and Nursing Care

Risk factors for SIDS

No single cause has been identified

Most common causes noted:

Prematurity

Brainstem defects

Infections

Genetic predisposition

Lower socioeconomic status, cultural influences

Smoking during pregnancy and exposing the infant to smoke,

Environmental stress (prone position)

Nursing Interventions for SIDS

Provide calm and compassionate support

Conduct interview in a calm, slow and non-threatening way

Infant should be cleaned, swaddled and presented to parents after death declared

Refer to local SIDS program

SIDS link: www.sids.org

Croup

Epiglottitis

Epiglottitis

Usual age range 3-7 yrs

May have stridor

Caused by **H.influenzae, but may staph and strep as well

Sudden onset

Sore throat and difficulty swallowing

May be an emergent situation

Lateral soft tissue of neck xray

Have equipment at bedside

Croup

Usual age range: 1-3 yrs

Inspiratory stridor

Harsh cough (barking)

Viral infection; afebrile

Gradual onset, usually at night

Improved with humidity; may need racemic epi

Treatable at home

Resolves spontaneously

Croup vs. Epiglottitis

Cardinal signs of epiglottitis

Drooling

Dysphagia

Dysphonia

Distressed inspiratory efforts

Nursing care for the child with epiglottitis

Observe for s/s respiratory distress

Assess respiratory rates: >60

Elevated temp ) 101º

The child must NEVER be left alone

NOTHING should be placed in the mouth (laryngeal spasms could result)

Croup

Racemic epi nebulization

Oral dexamethosone in a single dose

Acetaminophen

Humidified O2 and IVs for more severe cases

Sedatives are contraindicated

Epiglottitis

Child kept NPO

IV antibiotics

Antipyretics for fever

Emergency hospitalization

Medications for croup and epiglottitis

Bronchitis vs Bronchiolitis

The diameter of an infant’s airway is approximately 4 mm, in contrast to an adult’s airway diameter of 20 mm.

Bronchitis

Etiology

Inflammation of trachea and major bronchi

Usually viral (Rhino and RSV)

Occur with other conditions; may be confused with RAD (asthma)

Cough major symptom

Gradual onset of rhinitis

Productive cough (may be purulent) with  mucus

Crackles, rhonchi

Nursing considerations for a child with bronchitis

Increase fluids

Assess VS, secretions, respiratory effort

S/S sleep deprivation from cough

Antipyretics for fever

Quiet activities for diversion

Bronchiolitis

Etiology

RSV most common pathogen

May acquire from older siblings

Peak incidence @ 6 months

Mild upper respiratory incident precedes

Hyperinflation of the lungs on xray

Management of bronchiolitis

If mild, treated at home

Humified O2 if hospitalized

HOB elevated

Abx not given unless secondary bacterial intection

RSV prevention most important

Preventive measures against RSV

Follow droplet and contact precautions (can live on inanimate objects)

Nosocomial infections very common; strict hand hygiene must be observed